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SECOND REGULAR SESSION
HOUSE BILL NO. 3298
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE OVERCAST .
7069H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o repeal section 334.035, RSMo, and to enact in lieu thereof nine new sections relating to
the licensure of physicians.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 334.035, RSMo, is repealed and nine new sections enacted in lieu
2 thereof, to be known as sections 334.035, 334.333, 334.336, 334.339, 334.342, 334.345,
3 334.348, 334.351, and 334.354, to read as follows:
334.035. Except as otherwise provided in section 334.036, every applicant for a
2 permanent license as a physician and sur geon shall provide the board with satisfactory
3 evidence of having successfully completed [such postgraduate training in hospitals or medical
4 or osteopathic colleges as the board may prescribe by rule.] :
5 (1) A r esidency pr ogram accred ited by the Accredi tation Council for Graduate
6 Medical Education or its successor organization; or
7 (2) A state-accre dited res idency pr ogram appr oved by the board under sections
8 334.333 to 334.354.
334.333. 1. Sections 334.333 to 334.354 shall be known and may be cited as the
2 "Missouri State-Sponsor ed Residency Pathway Act".
3 2. As used in sections 334.333 to 334.354, the following terms mean:
4 (1) "Accr editation pathway", the accr editation of a res idency progra m as a
5 nationally accr edited res idency pr ogram or a state-accr edited r esidency prog ram;
6 (2) "Board", the state board of regist ration for the healing arts;
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
7 (3) "Demonstrated workfor ce shortage", a shortage of physicians in a particular
8 specialty as demonstrated by the satisfaction of one or mor e of the following objective
9 criteria:
10 (a) The specialty is identified as experiencing a curr ent or projected shortage in
11 a peer -r eviewed or publicly issued workforce repo rt by:
12 a. The department of health and senior services;
13 b. The Missouri Hospital Association;
14 c. A state university medical or public health pro gram; or
15 d. A federal agency with jurisdiction over health workforce analysis;
16 (b) The specialty demonstrates persistent access deficiencies including, but not
17 limited to:
18 a. A verage new-patient wait times exceeding thirty days for routine care; or
19 b. Documented physician-to-population ratios below national or state
2 0 benchmarks published by a governmental or academic entity; or
21 (c) The specialty is the subject of a formal finding or res olution of the general
22 assembly identifying a shortage impacting access to car e;
23 (4) "Health car e prov ider", a hospital, health system, federally qualified health
24 center , or health clinic;
25 (5) "Nationally accred ited res idency pr ogram", a res idency pr ogram accr edited
26 by the Accr editation Council for Graduate Medical Education or its successor
27 organization;
28 (6) "Pilot period", the period befor e January 1, 2030, in which the board may
29 limit appr oval of state-accr edited res idency pr ograms;
30 (7) "Residency prog ram" or "pr ogram", a postgraduate physician training
31 pr ogram;
32 (8) "Resident physician", a physician enr olled in a res idency pr ogram;
33 (9) "State-accr edited re sidency progr am", a res idency pr ogram appr oved by the
34 board under sections 334.333 to 334.354.
334.336. 1. The board shall establish and administer a process for appr oval of
2 r esidency pro grams as state-accr edited res idency pr ograms.
3 2. Any health car e pr ovider may apply to sponsor a state-accr edited res idency
4 pr ogram.
5 3. Except as prov ided by the board during the pilot period, appr oval to operate a
6 state-accr edited re sidency prog ram shall be based solely on compliance with the
7 statutory standards of sections 334.333 to 334.354.
8 4. The board shall not req uire national or private accre ditation of a res idency
9 pr ogram as a condition of state appr oval.
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10 5. During the pilot period, the board may limit appr oval of res idency progra ms
11 by rule. Any limit imposed by the board shall be based on:
12 (1) A cap imposed on the number of state-accredite d r esidency pr ograms. If a
13 cap is imposed, the board shall appr ove pr ograms on a first-come, first-served basis
14 until the cap is met; or
15 (2) The specialty of the prog ram or the geographic r egion in which the pr ogram
16 primarily operates. If the board limits appro val under this subdivision, the board shall
17 select specialties or geographic region s based on the need to impr ove access to care.
18 6. The board may promulg ate rules to implement appr oval criteria during the
19 pilot period and application proce dures for res idency pro grams that apply for appr oval
20 during or after the pilot period. Any rule or portion of a rule, as that term is defined in
21 section 536.010, that is crea ted under the authority delegated in this section shall
22 become effective only if it complies with and is subject to all of the provi sions of chapter
23 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable
24 and if any of the powers vested with the general assembly pursuant to chapter 536 to
25 r eview , to delay the effective date, or to disappr ove and annul a rule are subsequently
26 held unconstitutional, then the grant of rulemaking authority and any rule pr oposed or
27 adopted after August 28, 2026, shall be invalid and void.
334.339. Each state-accr edited res idency pr ogram shall meet the following
2 minimum req uirements:
3 (1) The pro gram shall provi de training of a duration sufficient to ensur e that
4 r esident physicians achieve clinical competency in the applicable specialty . The board
5 shall consider the duration req uirement for training under this subdivision satisfied
6 despite a progr am length shorter than the customary national progra m length if:
7 (a) The pr ogram is in family medicine or another specialty experiencing a
8 demonstrated workforce shortage;
9 (b) The pr ogram demonstrates, thr ough objective competency-based standards,
10 that res ident physicians in the progra m will achieve outcomes for clinical proficien cy ,
11 patient safety , and scope-of-practice rea diness equivalent to those achieved by graduates
12 of longer pr ograms;
13 (c) The shortened duration does not eliminate essential clinical rota tions or
14 r equir ed core competencies for the specialty; and
15 (d) The pro gram includes enhanced supervision, evaluation, and competency
16 verification mechanisms sufficient to ensur e that the quality of training is not
17 diminished;
18 (2) The pr ogram shall ensur e that the practice of medicine by res ident
19 physicians is under the supervision of physicians who hold an unr estricted license to
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20 practice medicine in this state and who possess demonstrated competence in the
21 specialty ar ea;
22 (3) The pro gram shall ensur e that the patient volume and diversity of clinical
23 experience ar e sufficient for re sident physicians to achieve competency in the specialty;
24 (4) The prog ram shall implement written evaluation, re mediation, and dismissal
25 pr ocedur es for the res ident physicians; and
26 (5) The pr ogram shall comply with all applicable state laws rel ating to patient
27 safety , quality r eporting, and pr ofessional conduct.
334.342. 1. The board shall not r equir e any postgraduate training in addition to
2 the postgraduate training in a res idency pr ogram req uire d under section 334.035 to
3 obtain permanent licensur e as a physician.
4 2. The board shall not vary the r equir ements for licensure as a physician based
5 on the accred itation pathway of the res idency pr ogram completed by the physician.
334.345. 1. The privilege of a physician licensed in this state to practice medicine
2 in any hospital, clinic, or health care facility in this state shall not vary based on the
3 accr editation pathway of the r esidency pro gram completed by the physician.
4 2. A hospital or health system shall not deny staff privileges to a physician
5 licensed in this state based solely on the accr editation pathway of the re sidency pr ogram
6 completed by the physician.
334.348. 1. Except as pr ovided during the pilot period, any denial, limitation, or
2 r evocation of appr oval of a state-accr edited res idency pro gram shall be based solely on
3 failur e to meet expr ess statutory requ irem ents. Any denial, limitation, or revo cation
4 shall be in writing and state the specific statutory gr ounds for the action or , if the action
5 occurr ed during the pilot period, the specific statutory or regu latory gr ounds for the
6 action.
7 2. Any state-accr edited res idency pr ogram that has had its appr oval denied,
8 limited, or revok ed by the board may seek a review of the board's action by the
9 administrative hearing commission.
10 3. This section shall not be construed to grant the board authority to impose
11 r equir ements not expr essly authorized by statute.
334.351. 1. Nothing in sections 334.333 to 334.354 shall be construed to:
2 (1) Guarantee eligibility for federal graduate medical education funding; or
3 (2) Require any other state to accept completion of a state-accr edited res idency
4 pr ogram for the purposes of licensur e or authorization to practice in that state.
5 2. Nothing in sections 334.333 to 334.354 shall be construed to limit, rep lace, or
6 interfer e with nationally accr edited res idency pr ograms operating within this state.
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7 3. The department of social services may seek any federal waiver , state plan
8 amendment, or other federal appr oval necessary to maximize federal re imbursement of
9 health care services pr ovided by res ident physicians consistent with sections 334.333 to
10 334.354.
334.354. 1. Sections 334.333 to 334.354 shall not be subject to the pr ovisions of
2 the Missouri sunset act under sections 23.250 to 23.298.
3 2. Befor e January 1, 2037, and every ten years ther eafter , the board shall submit
4 a rep ort to the general assembly containing:
5 (1) Data on the state-accr edited resi dency progra ms appr oved by the board
6 including, but not limited to:
7 (a) The number of prog rams appr oved by the board;
8 (b) The geographic r egions in which the pr ograms primarily operate;
9 (c) The number and type of specialties offer ed by the pro grams; and
10 (d) The number of physicians who graduated from the pro grams;
11 (2) Data on the workforce participation of graduates of state-accr edited
12 r esidency pro grams, including data disaggr egated by specialty , type of employer , and
13 geographic region ;
14 (3) Data on the outcomes for clinical pro ficiency , patient safety , and scope-of-
15 practice read iness achieved by graduates of state-accr edited res idency pro grams as
16 compar ed to the outcomes achieved by graduates of nationally accre dited res idency
17 pr ograms; and
18 (4) Data on insurance r eimbursement practices for health car e services pr ovided
19 by r esident physicians and graduates of state-accre dited r esidency prog rams.
✔
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